NHS Fife Equality Plan 2017-2021

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NHS Fife Equality Plan 2017-2021
NHS Fife Equality Plan
NHS Fife Equality Plan 2017-2021
If you require this information in a community language or alternative format
e.g. Braille, audio, large print, Easy Read please contact the Equality and Human
Rights Team at: email: fife-UHB.EqualityandHumanRights@nhs.net or phone 01592

If you have a hearing or speech impairment please contact NHS Fife via SMS text
service number 07805800005

If you would like assistance to access this plan or with help please also contact our
partner agencies at:

Deaf Communication Service
2 Wemyssfield
Kirkcaldy, KY1 1XW
Phone: 03451 551503
Email:    swinfo.deafcommunications@fife.gov.uk
Internet : Deaf Communication Service

The Fife Centre for Equalities
New Volunteer House
16 East Fergus Place
Kirkcaldy, KY1 1XT
Phone: 01592 645310
Email:    info@centreforequalities.org.uk
Internet: Fife Centre for Equalities

NHS Fife Equality Plan 2017-2021
Contents                                                                               Page

1. NHS Fife’s Corporate Equality and Human Rights Statement                            4
2. NHS Fife Equality and Human Rights Executive Lead Welcome                           5
3. NHS Fife Equality and Human Rights Lead Introduction                                6
4. NHS Fife Employee Information Introduction                                          7
5. NHS Fife Board Membership; Board Diversity Statement                                8
6. Background and NHS Fife’s Progress Equality and Mainstreaming Progress Report       9
7. Understanding Fife’s Population                                                     10
8. Equality Plan – Embedding Equality Practice in Our Daily Work                       15
9. Improving Patient and Community Relations; Fostering Good Relations                 18
10. Improving access and Information for British Sign Language (BSL) Speakers to       20
   Eliminate Unlawful Discrimination
11. Promoting Health of Looked after Children to Ensure Improved Health Outcomes, by   22
   Advancing Equality of Opportunity and Eliminating Discrimination
12. Reducing Stigma of Mental Illness to Eliminate Unlawful Discrimination             24
13. Improving Access to Services for People Experiencing Discrimination on the         25
   Grounds of Poverty
14. Providing Ethically Sourced Goods and Services                                     26
15. NHS Fife Equality Outcomes Plan 2017-2021                                          28
Contact Details                                                                        52
Accessible Communication Statement                                                     53

NHS Fife Equality Plan 2017-2021
1. NHS Fife’s Corporate Equality and Human Rights Statement

     NHS Fife is committed to making health and care accessible by
  eliminating discrimination, promoting inclusion and ensuring a Human
    Rights based approach underpins all our functions and services.

  Aithris Chorporra NHS Fhìobha air Cò-ionannachd agus Còraichean
 Is e rùn NHS Fhìobha cothroman cùram-slàinte fhosgladh le bhith a’ cur
às do leth-bhreith, a’ brosnachadh in-ghabhail agus a’ dèanamh cinnteach
  gu bheil còraichean daonna mar bhun-stèidh nar n-uile gnìomh agus

NHS Fife Equality Plan 2017-2021
2.     NHS Fife Equality and Human Rights Executive Lead Welcome

Helen Wright, Director of Nursing, Equality and Human Rights Executive Lead,
NHS Fife

Welcome to NHS Fife’s Equality and Mainstreaming Plan for 2017-2021.

The founding principles of the NHS are based on those of our Human Rights, in particular our right
to life. It is therefore of no coincidence that the First Declaration on Human Rights was drafted in
the same year as the NHS was formed. Both are intrinsically linked by their Universalist principles
of social justice and opportunity for all. We can still see in today’s NHS how these principles have
continued to underpin the NHS, regardless of the changing social needs, or the medical advances
in health or the new partnerships in care recently established. This is evident in the patient centred
care we provide, the work to reduce inequalities in health and service developments which aim to
ensure that our services are accessible for all.

Our strong emphasis on Patient Rights helps to put these principles into our every day work. The
Patient Rights Act of 2011 has added further strength to our determination to listen to the
communities across Fife, whether faced with discrimination or disadvantage, and seek to
understand their health needs. These important Human Rights principles in healthcare are evident
throughout the organisation and are integral components of the NHS Board corporate function,
which demonstrates our commitment and leadership in this area. We aim to make continual
improvements to really embedding Human Rights and Equality throughout all functions in NHS
Fife. We aim to continue to seek and listen to the voices of the disadvantaged, marginalised and
underrepresented, creating conditions and cultures which make NHS Fife fairer and more equitable
and within which care is provided with dignity and respect.

NHS Fife Equality Plan 2017-2021
3.     NHS Fife Equality and Human Rights Lead Introduction

Dianne Williamson, Equality and Human Rights Lead, NHS Fife

Since our first Equalities and Mainstreaming Plan in 2013, NHS Fife has continued to drive forward
changes within services which aim to eliminate discrimination and improve the experiences of
communities across Fife, making NHS Fife a fairer and more equitable organisation for staff and

Following the first Equality and Mainstreaming report in 2013 a further progress report was
published in 2015. The progress report detailed achievements against those outcomes and
mainstreaming activity at the interim point. At this stage the report also added a further two

NHS Fife has and will continue to make progress towards our Public Sector Duties as set out in the
Equality Act (2010) and Equality Act (Specific Duties) (Scotland) Regulations 2012, which came
into force in May 2012.

This plan details our work towards making equality a normative part of service provision and
corporate function to reduce inequalities in health and promote equality of opportunity, eliminate
discrimination and to foster good relations.

NHS Fife Equality Plan 2017-2021
4. NHS Fife Employee Information Introduction

Brian McKenna, Human Resources Manager, NHS Fife

When the Equality Plan and Equality Outcomes for 2013-17 were introduced, the information NHS Fife
retained about our workforce varied between protected characteristics (PC’s). This information would
have been described as incomplete.        Since 2013, considerable improvement has been made in
capturing PC data, and whilst this momentum needs to be maintained, sufficient data is now captured
which allows for the publication of employee information showing how representative our workforce
is of the population we serve.

The challenge in 2017-21, in conjunction with our partners in the Health & Social Care Partnership
and beyond, is to determine how to utilise this employee information to maximise our contribution
to the General Equality Duty. For example, the changing landscape in Fife, which will see the
numbers of the population in the typical working-age bracket of 16-60 reducing; increases in the
population who consider themselves as meeting the definition of disabled; and uncertainty caused
by the result of the referendum on leaving the European Union, all bring challenges to our
workforce. Our response to these challenges needs to ensure we advance the opportunities of
people who share protected characteristic(s) and foster relations for people who share protected
characteristic(s) and those who do not.

During 2017-21, NHS Fife continues to be committed to ensuring our workforce reflects the
diversity of the population we serve, and in response to the challenges described above, our
Equality Outcome incorporates the following activities:

   i.     Improving access to work for those members of the local population who are distant from
          the labour market;
   ii.    Making visible to the public the diverse communities and cultures represented within the
          NHS Fife workforce;
   iii.   Improving the employment experience of minority groups represented in the workforce;
   iv.    Fostering a culture which improves the understanding and relations between people who
          share a protected characteristic(s) and those who do not.

NHS Fife Equality Plan 2017-2021
5.         NHS Fife Board Membership; Board Diversity Statement

NHS Fife makes a clear and consistent commitment to Equality and Human Rights throughout the
organisation by demonstrating diversity at a senior level and amongst Board members.

NHS Fife will appoint a Non Executive Board member to lead the Board in the design and
development of a diverse Board membership succession plan, which will pay particular attention to
diversity and inclusion.

At present NHS Fife Board consists of: 4 men and 10 women

Non Executive Board Member-Male:
•       Martin Black, Non Executive Member
•       John Paterson, Non Executive Member
•       Simon Little, Non Executive Member

Non Executive Board Member-Female:
    •    Moira Adams, Non Executive Member
    •    Christina Cooper, Non Executive Member
    •    Alison Rooney, Non Executive Member
    •    Rona Laing, NHS Board Chair person

    •    Paul Hawkins, Chief Executive

    •    Frances Elliot, Executive Member
    •    Margaret Hannah, Executive Member
    •    Helen Wright, Executive Member
    •    Mrs Carol Potter, Executive Member
    •    Wilma Brown, Stakeholder Member
    •    Janette Owens, Stakeholder Member

NHS Fife Equality Plan 2017-2021
6.       Background and NHS Fife’s Equality and Mainstreaming
Progress Report

The NHS Fife Equality and Mainstreaming Plan of 2013 was followed by the interim Equality and
Mainstreaming Progress Report, published in 2015. The NHS Fife Equality Progress Report
provided information on the range of actions taken to meet our obligations of the Equality Act
(2010) and Public Sector Duty Act (2012).

Following submission of the NHS Fife Equality Progress Report in 2015, NHS Fife has continued to
make a fairer and more equitable NHS for everyone. The focus to increase and expand Equality
across the Health services provided extends beyond the limitations of this report. Many examples
of equality in practice occur every day throughout NHS Fife. This will continue as we progress over
the next four years. The full final progress report can be read here:

    Progress on
Mainstreaming and Eq

The Equality Outcomes that were set in 2013 and extended as part of the NHS Fife Equality
Progress Report in 2015 included:
•    Respect and dignity for older people must be integral to all our work.
•    Parents have access to world class antenatal, maternity and post natal care that meets their
     individual needs.
•    People with learning disabilities are enabled to optimise health, wellbeing and social inclusion
     whilst recognising the need for specialist input when required.
•    People with sensory impairment are engaged in their process of care in ways which allow them
     to share their concerns like anyone else would.
•    Understanding health needs and work collaboratively with Lesbian Gay, Bisexual and
     Transgender community in Fife.
•    Demonstrate cultural competence when providing healthcare for people from different ethnic
     groups - to break the cycle of poor health and disadvantage to people from different ethnic
     groups - to enable fair treatment for everyone.
•    The workforce reflects the diversity of the population.
•    NHS Fife is an Ethical Consumer of Goods and Services.
•    Reducing Stigma of Mental Illness.
•    Improving access to people experiencing discrimination on the grounds of poverty.

NHS Fife Equality Plan 2017-2021
NHS Fife will carry forward two of the original outcomes as mainstreaming elements of the NHS
Fife Equality Plan for 2017-2021. These are a result of continuing local developments in reducing
mental health stigma across Fife and in relation to the new equality duty around reducing
discrimination on the grounds of poverty. These therefore are continued:
•    ‘Improving access to people experiencing discrimination on the grounds of poverty’ will
     continue as ‘improving access to services for people experiencing discrimination on the
     grounds of poverty’.
•    ‘Reducing Stigma of Mental Illnesses.

7.       Understanding Fife’s Population

Fife has a population of 368,080 with many different communities residing within its co terminus
boundaries with Fife Council within which there are seven localities and Community Planning
Partnerships. Locality and clusters will take a similar geographical setting.

   Fife Population
Protected Characteris


                                      The median age of Fife’s residents is 43 years. 17% of the
                                      Fife’s population are children (0-15), 63% are of working age
                                      (16-64) and 20% are aged 65 and over. There are currently
                                      31,220 persons aged 75 and over living in Fife, 8.5% of the
                                      total population. There are variations in population age
                                      structure within Fife.

Three of Fife’s seven localities have higher proportions of
their population aged 65 and over compared to Fife;
Kirkcaldy (20%), Levenmouth (21.2%) and North East Fife
with 21.5%. In contrast, Dunfermline’s older population is
significantly less than Fife at 16.1% but its proportion of
children is the highest of all seven localities at 19.4%.
Dunfermline also has the largest proportion of its population working age; 64.3% closely followed

by North East Fife with 64.2% which in turn has the smallest proportion of children among its
population at 14.5%.

Fife in common with Scotland has a growing and ageing population. The 2014 - based population
projections estimate that Fife’s overall population will increase to 386,963 in 2039. Overall the
population of Fife is set to increase by 5% but increases will not be seen in all age groups. A 2%
increase is projected in the number of younger Fife residents aged 0 to 15 by 2039 but during the
same time period Fife is projected to have a decrease of 8% in the number of persons aged 16-64.
The largest increases will be seen in persons aged 75 and over. By 2039 the number of persons
                                    aged 75 and over is projected to be almost 60,000, a rise of
                                    91%. Chart 1 show how the bulk of the population will move
                                    from between approximately 40 to 60 in 2014 to 65 to 80 in
                                    2039 for both males and females. From 2029 the number of
                                    persons aged 75 and over in Fife is estimated to exceed the
                                    number of persons aged 65-74.


The Equality Act 2010 defines a person as having a
disability of they have a) a physical or mental impairment,
and (b) the impairment has a substantial and long-term
adverse effect on their ability to carry out normal day-to-
day activities. The 2011 Census is the most recent large
scale source of questions on long term conditions and
whether these limit day to day activities, but questions are
also included in other major population surveys undertaken
in Scotland.

Marriage and Civil Partnership

In 2015 there were 1667 marriages registered in Fife. Of
these 1587 were opposite sex couples and 80 were same
sex couples. 2015 was the first full year since the
introduction of the Marriage and Civil Partnership Act
Scotland (2014) which explains the drop in the number of

Civil Partnerships between 2014 and 2015. The number of marriages registered in 2015 was an
increase of 53 on the 1,614 registered in 2014 but the overall trend since the early 1990s has been
a reduction of 25% in the number of marriages registered in Fife. Nationally the average age at first
marriage is increasing and was 33.6 years for males and 31.9 years for females in 2015 compared
to 31.9 and 29.9 years of age in 2005 and 24.3 and 22.5 years in 1975.

Pregnancy and Maternity

                             In 2015 there were 3,719 maternities resulting in 3,755 live births
                             registered in Fife. This was 134 fewer births than in 2014 and the lowest
                             number of live births since 2004. Of these births just over half were baby
                             boys (50.3%). More than half of all babies were born to unmarried
                             parents having accounted for 57% of all live births in Fife compared to
                             51% across Scotland. The average age of parents continues to increase
                             and across Scotland was 30.2 for mothers and 32.8 for fathers in 2015.
                             Among Fife births in 2015; 3.3% were to mothers aged 40 and over,
                             15% to mothers aged 35-39, and 5% to mothers aged less than 20 years


In the 2011 Census, 97.6% of the population of Fife described their
ethnicity as ‘White’, a decrease of approximately 1% on the 98.7%
reported in 2001 (Table 1). Within this grouping the most commonly
reported category was ‘White Scottish’ stated by 85.7% of the Fife
population followed by ‘White Other British’ stated by 8.6%. A new
category for the 2011 Census showed that there were just over 3,000
persons living in Fife who stated they were ‘White Polish’, 0.8% of the
total population.

A separate ‘White Gypsy/Traveller’ response category was also added to the Census in 2011. 316 people
in Fife recorded their ethnic group within this category corresponding to 0.1% of the population of Fife. This
proportion was the same as that recorded nationally but compared to other council areas Fife had the fourth
(of 32) largest number of people who identified themselves as ‘White Gypsy/Traveller’.

Table 1: Population of Fife by broad ethnic group; 2001 and 2011 Census

                                                     White:                           African,
                                          White:                 White:
                            White                    Gypsy/               Asian       Caribbean or
                                          Scottish               Polish
                                                     Traveller                        Black
            2001 – No.      345,003       308,371    -           -        2,734       490
            2001 - %        98.7          88.3%      -           -        0.8         0.1
            2011 – No.      356,550       312,957    316         3,058    5,748       1,126
            2011 - %        97.6          85.7       0.1         0.8      1.6         0.3

Source: Scroll and Census Data Explorer

There have been increases in all of the minority ethnic groups in Fife in the last ten years with the largest
increase seen in the proportion of people in Fife who stated they were ‘Asian’ (a grouping which includes
Indian, Pakistani, Bangladeshi and Chinese). In the 2011 Census this was 1.6%, double the 0.8% reported
in 2001 (Table 1). There was also an increase from 0.1% to 0.3% in people classifying themselves as
‘African, Caribbean or Black’.4

                                                                            There were also geographical
                                                                            differences     in   ethnic     group
                                                                            populations living across Fife.
                                                                            The Kirkcaldy locality had the
                                                                            largest proportion of residents
                                                                            who were ‘White Polish’ at
                                                                            2.3% followed by Glenrothes
                                                                            Locality at 0.8%. 98.5% of the
                                                                            population      living     in     the
                                                                            Cowdenbeath          Locality    area
described themselves as ‘White Scottish, British or Other White’ slightly more than the locality
areas of Levenmouth (98.3%) and South West Fife (97.9%). Within the main towns in Fife,
Kirkcaldy has the largest ‘White Polish’ population with 43% of the total ‘White Polish’ population in
Fife living there representing 2.7% of the total population of Kirkcaldy. St Andrews had the largest
proportion of people being of ‘Asian’ ethnicity, 8% of its population, which corresponded to almost a
quarter (24%) of the ‘Asian’ population in Fife. Approximately a quarter (24%) of ‘African,
Caribbean or Black’ Fife residents lived in Dunfermline and a further 21% in Kirkcaldy.

Religion and Belief

                      As part of the 2011 Census Fife residents were asked which current
                      religious denomination or body they belonged to, or to state if they did not
                      have a religion. Nearly half of Fife’s residents stated that they did not have a
                      religion (46%). The most frequently chosen religion was Church of Scotland
                      (31%) followed by Roman Catholic (9%). Fife’s residents who identified
                      themselves as belonging to the Church of Scotland were more likely to be
                      older than those who belonged to
                      other religious groups. Almost a
                      third of those belonging to the
Church of Scotland group were aged 65 and over
compared to 24% of Roman Catholics and 4% of Muslims.
Of those who identified themselves as Muslims the
majority were younger adults, 40% were aged between 16
and 34, a pattern that was evident among the other religious groups of Jewish, Hindu, Buddhist
and Sikh.


                                         There are more women than men living in Fife; 52% of the
                                         total population are female. The median age of women is
                                         slightly higher than of men; 44 years compared to 42
                                         years. This is reflected in the fact that 24% of women are
                                         of pensionable age compared to 18% of men and of the
                                         population aged 75
                                         and over 59% are
                                         females      and   41%
are males. Life expectancy at birth is greater for women than
for men; 81.5 and 77.7 years respectively.

Sexual Orientation

                         At present there is only limited data collected on the experiences of gay,
                         lesbian and bisexual or other –people in Scotland. As part of the Scottish
                         Governments core survey dataset a question on sexual orientation was
                         introduced to the major large scale population surveys undertaken each
                         year. The figures included in this dataset are likely to be an under
                         representation of the percentage of gay, lesbian and bisexual people in
                         Scotland for a number of reasons including perceptions of the intrusive
                         nature of such questions and as such the
results should be treated with caution. 1.6% of the total number of
respondents in the core dataset stated their sexual orientation as
‘gay, lesbian, bisexual or other’. Of the respondents living in Fife
the proportion was 1.4%.        Almost half of ‘LGB & other’
respondents were aged under 35 years old.

8.     Equality Plan – Embedding Equality Practice in our Daily Work

NHS Fife will ensure that we take forward the Equality Outcomes specifically referenced in this
document but that we also continue to make progress throughout the whole organisation and fulfil
our legal obligations but even more so because it is just the right thing to do for all our staff and

Common every day personalised patient centred care and best practice in promoting and ensuring
Equality and Human Rights can mean that it is often overlooked and goes undocumented however
we are able to make assessment of the overall care and experience provided for our communities,
providing measured improvements in professionalism and standards of care.

There are many different ways in which we can monitor and measure improvements in Equality
across NHS Fife. Some of these measures are listed against the outcomes, but some of them will
be documented as part of a range of other corporate functions. These include for example our work
to improve public participation and involvement, improving diversity at committee and at senior
leadership levels, improving patient feedback from groups often underrepresented and the
monitoring of and learning from patient complaints.
•   NHS Fife aims to identify staff with a particular interest in Equality and Human Rights. This
        will help to increase knowledge of cultural and health needs across services. Our staff
        champions will continue to take forward learning and equality messages into work areas.

Patient Comments and Complaints

Patient comments and complaints are in the management of the Patient Relations Team and are
accountable to NHS Fife Board members. Regular analysis of the patient data is collated and
presented at various committees. NHS Fife intends to learn from the information available, but also
to demonstrate improvements, so a baseline of this data will be collated and analysed year on
year, highlighting examples of patient’s comments that are both positive and negative. We will learn
from both sets of data, sharing the learning and the patient experience at various forums or groups.
NHS fife will follow through any requirement for improvement in the patient experience and ensure
that any acts of discrimination are addressed.

•   NHS Fife is currently developing short films which demonstrate examples of equality in practice
    from across a range of NHS Fife services.
•   Patient stories will also be presented at NHS Fife Board meetings, NHS Fife committees and
    public and participation networks, which will give insight into the patient experience. We aim to
    improve awareness, foster good relations between staff, patient of NHS Fife and the Fife
    community and learn from these stories to make improvements to patients experience and

Hate Crimes and Incidents

Hate crimes and incidents are provided in a quarterly analysis report. These are actively
addressed, with support for staff and patient or additional measures aimed at reducing the lively
hood of the incidents being repeated. NHS Fife has a lead Community Safety Officer and manages
NHS Fife Violence and Aggression Group, responsible for a program of work aimed at reducing
discrimination. NHS Fife actively seeks hate crime reporting and responds to these issues for front
facing staff and patients. The Incident reporting system regularly reports the levels of incidents and
monitors the location and outcome. Recent developments to the incident recording system have
improved the categorisation of hate incidents and crime.

Domestic Violence

NHS Fife works closely in partnership with various local and national organisations. Fife Violence
against Woman Committee steers the agenda to eliminate violence against women and girls. The
aim is to provide a ‘Scotland were all individuals are equally safe and respected, and where
women and girls live free from all forms of violence and abuse-and the attitudes help perpetrate it.
NHS Fife supports delivery of the local VAW actions plan by providing training and advice to staff,
participating in multiagency Risk Assessment conferencing and supporting joint working where the
individual requires ongoing care or treatment. NHS Fife will promote positive gender roles in
appropriate project work and seek to early identify domestic abuse throughout services, by
focussing on particular settings such as mental health, addictions, women’s services and at
Accident and Emergency.

Staff Training

NHS Fife continues to grow the range of training opportunities available for staff. Each year over
3032 staff are trained using the on line learning module ‘Equality and Human Rights’ as part of their
induction program. NHS Fife has recently added modules such as ‘Carers’, ‘Deaf Awareness’,
‘Stonewall’ and ‘Raising Awareness of Gypsy Travellers Communities’ of which a total of 109 staff
completed the Gypsy Traveller module in the past year.

NHS Fife Health Promotion Department manages the ‘Health Inequalities Training Programme’ and
an ‘Information and Resources’ Department. The training offered via the Health Promotion Training
Programme (2016-2017) focuses on areas such as prevention and early intervention,
understanding the needs of key groups (who are more likely to experience poor health and
wellbeing) and providing opportunities to learn from local projects.

We continue to source and promote additional learning opportunities including further on line

•   NHS Fife will develop and provide a series of short talks, lunchtime bytes sessions including for
    General Practice offering a ‘menu’ of learning opportunities.

NHS Fife intends to do more to highlight and exemplify examples of excellence throughout the year
and will develop a project which promotes the National Health Services historic and landmark
achievements, exemplifying the significant contribution the NHS makes to Equality. This project will
promote Human Rights across Fife communities, enabling us to promote and educate the
population on the Human Rights based approach, with the aim being to enable people to exercise
those rights. A particular focus will be on Women’s and Children’s Rights, connecting this agenda
with GIRFEC and young people’s rights to access health.

•    NHS Fife will commence this work by engaging and supporting a group of young people
     experiencing disadvantage and difficulty, to design and draft the project, helping them to learn
     about their Human Rights and to present their project to NHS Fife. The project will be hosted
     throughout various settings over the next few years.

9.     Improving Patient and Community Relations; Fostering Good Relations

The PANEL Principles

The PANEL Principles: Participation, Accountability, Non-
discrimination,   Empowerment      and    Legality    (Scottish
Human Rights Commission, 2015) help us to protect and
fulfil Patient Rights and promote fairness and equality.

•    Participation - Everyone has the right to participate in decisions which affect them. Participation
     must be active, free, and meaningful and give attention to issues of accessibility, including
     access to information in a form and a language which can be understood.
•    Accountability - Requires effective monitoring of Human Rights standards as well as effective
     remedies for Human Rights breaches.
•    Non-discrimination and Equality - A Human Rights based approach means that all forms of
     discrimination in the realisation of rights must be prohibited, prevented and eliminated.
•    Empowerment - Individuals and communities should understand their rights and should be fully
     supported to participate in the development of policy and practices which affect their lives.
•    Legality - A Human Rights based approach requires the recognition of Rights as legally
     enforceable entitlements and is linked in to national and international Human Rights law.

NHS Fife has embedded these principles in the work to improve the public engagement and
participation structure.

NHS Fife will:
•   Establish a forum to take responsibility for driving the participation and engagement agenda
    and ensuring alignment and coordination across all work streams, really embedding the patient
    and public viewpoint.
•   We will ensure that the new forum will include a wide range of stakeholders.
•   We will source ‘Ambassadors’ from our planning areas across Fife to ensure that many
    different views are heard.
•   And we will have structures which enable those voices to be heard.

NHS Fife will work closely with a range of Third sector providers. The Third sector offers us the
additional opportunity to address causes of health inequality including patient concerns around
housing, welfare and support needs. Our intention is to ensure, that as the range of community
support groups develop that we establish working arrangements which will help us to sign post and
refer patients who require community based social and financial supports.

•   NHS Fife will ensure that services become aware of the role of the ‘Local Area Coordinators’
    and that health services are able to sign post appropriately.
•   The Health Promoting Healthcare Services framework will also support the patient’s right to
    health information and support for social aspects of their care whilst in Hospital.

The local Fife Carers Centre will work closely with us and in developments to connect carer’s
needs with advocacy provision and support from interpreting and translation services to ensure
patients are able to access services.

‘Disabled people's access to justice, in particular
advice services.... This is particularly important at this
time of welfare reform and the impact of measures on
disabled    people’    (Scottish   Government,      Equality
Outcome, 2013).

The Advocacy Strategy for Fife (2014/2017) and partnership work with our local advocacy
providers via the Fife Advocacy Forum will help us to provide access to welfare information, as well

as social supports and financial advice for those living with a disability. The strategy will be
refreshed during 2017 with a new plan in place by 2018.

•     We aim to improve knowledge of patient’s rights for people accessing Advocacy-as those
      patients can be some of the most vulnerable.
•     NHS Fife will participate in mapping the extent of advocacy requirements and provision.
•     NHS Fife will ensure that advocacy is extended to enable people’s rights to exercised
      throughout their time with health services. Further work to monitor and measure advocacy as
      part of health care will be put in place.
•     NHS Fife aims to promote access to advocacy via a range of awareness sessions and events.
•     NHS Fife will ensure that our Equality and Human Rights lead officer is a core member of the
      Advocacy Strategy Group and the Local Advocacy Providers Forum, thereby embedding
      Human Rights approaches from NHS practice into our work with providers.

   Patient Rights        Fife Advocacy     Participation and
(Scotland) Act 2011   Strategy 2014-2017 Engagement Strategy

10.     Improving Access and Information for British Sign Language (BSL)
Speakers to Eliminate Unlawful Discrimination

‘BSL is a language in its own right, having been officially recognised by the
UK Government in 2003 as being a full, independent language. It is the
most common form of signed communication used by Deaf people in
Scotland’ (Scottish Government, Analysis of Equality Results, part 2, 2015).

The 2011 Census was the first to ask questions on the use of British Sign
Language (BSL) at home. The information provided told us that in Fife there are 951 who indicated
that they used BSL at home which was 0.27% of the population. Of those who used BSL in Fife,
46% were male and 54% were female. 195 of BSL users in Fife were children (aged 3 to 15) and
130 were aged 65 and over.

Scotland’s National Action Plan and the British Sign Language (BSL) Act 2015, aims to raise
awareness of BSL and improve access to service for those who speak BSL. This area of work will

commence during 2017 with the BSL community, working with us to formulate a local BSL action

In anticipation of the local action plan, NHS Fife has continued to further extend our participation
and engagement with the BSL community. A welcome message informing the BSL community of
how to get in touch, be involved and make comment will be recorded in BSL and made available on
the NHS Fife website. This will be promoted during Deaf Awareness week along with information
for staff and patients.

•   We will continue to learn from and understand the needs of the BSL community by regularly
    meeting with BSL speakers and involving them in the work of the Participation and
    Engagement network and forum.
•   We will draft and monitor the BSL patient experience, presenting these to services and
    corporate functions with the aim to raise awareness and make service improvements.
•   We aim to improve the range of materials available to our BSL community, ensuring they have
    equal access to health information.

‘BSL speakers were almost three times as likely to be 'permanently sick or disabled' (Scottish
Government, Analysis of Equality Results, Part 2, 2015).

NHS Fife will work more closely with the Deaf Communication Service, Fife Council to ensure that;

•   We improve identification patients who speak BSL.
•   To ensure additional support for BSL speakers.
•   That any support needs are embedded into the preparation for admission or attendance
    including identification of BSL patients on the patient record.

In addition, and in preparation for care, we will put in place face-to-face staff awareness sessions,
provided on staffs working base, whether that is wards,
community     settings    or   in   departments   to    enable
improvements in patient centred care. These learning
sessions will be provided by local Deaf groups and Fife
Council Deaf Communication Service.

Fife Sensory      BSL (Scotland) Act
Impairment Strategy         2015

11. Promoting Health of Looked after Children to Ensure Improved Health
Outcomes,              by      Advancing   Equality     of   Opportunity        and     Eliminating

In Scotland 3.6% of children who are looked after will have multiple disabilities, 3.5% will have
social, emotional and behavioural difficulties. In Fife, every year, over 900 children are looked after
(this includes Kinship care arrangements), with 136 at home and approximately 479 in foster care).

Approximately 3 children and young person are received into care each week in Fife.

Looked after Children, are more likely to experience poorer health outcomes as a result of a range
of inequalities stemming from their background and / or early years. Early intervention which
addresses the root causes of inequality and providing the best start in life are set out in the Early
Years Framework (Scottish Government, 2008) and Getting it Right for Every Child (Scottish
Government, 2014) NHS Fife aims to address health Inequalities for Looked After Children as part
of the actions taken to improve health and wellbeing.

•    NHS Fife will provide a LAC Health Assessment for all LAC children, supporting access to
     adult services and addressing immediate health needs.
•    NHS Fife will continue to highlight the need for all LAC to have an advocate to support them in
     their choices, reducing disadvantage and discrimination in access to services, support and
•    NHS Fife will ensure a competency framework is in place for all nursing provision for LAC, to
     ensure the best standard of care is provided for the most vulnerable children.

In 2015, NHS Fife undertook a consultation with children, young people and their families to which
aimed at finding out more about their experiences of NHS Fife Children’s Services. The aim of the
consultation was to ensure that NHS Fife takes action to improve those experiences of children
and young people and reduce discrimination.

We received feedback from 355 children, young people and parent/carers in Fife with 71% of the
participants being 18 years old or less.

The common themes which they told us that mattered to them were mainly in relation to how we
communicate with young people in relation to their involvement and decision making of their care:

                   “Welcome us”“Speak to us”“Include us”“Don’t judge us”“Support us”

These themes informed the ‘Children and Young people’s Health and Wellbeing’ Strategy
(Children and Young People’s Health and Wellbeing Strategy, NHS Fife, 2015-2020) and a range
of developments aimed at improving child centred care.

  Corporate Parent Children and Young Young People Act    NHS Fife Child Health Childrens services
Board ImplementationPeople (Scotland) Act 2014 - Rights   and Wellbeing Strateg plan 2014-2017

Children and young people want to feel valued in all circumstances and staff should create
opportunities to celebrate diversity. Children and young people would like NHS Fife staff to be non
judgemental and respectful of their needs; recognising that they are young individuals who will
make mistakes and that they don’t always understand things due to lack of life experience.

•    NHS Fife will seek to further children and young people’s participation and will take forward
     their involvement in the design of all children and young people’s health information.
•    NHS Fife will improve awareness of youth culture and diversity including the needs of LGBTi+

            ‘You have the right to an opinion and for it to be listened to and taken seriously’
                                                   Article 12 URCRC

Young people told us that we should be communicating with them in a way they are familiar with
so we will extend the role of technology for young people to enable them to access both health
information and services.

•    NHS Fife will make better use of social media and the internet for communicating and provide
     a reliable, easy-to-access online resource for children and young people.

Having competent, experienced staff who demonstrate empathy and understanding of both child
development and the issues that affect children and young people was felt by many to be an
essential requirement to support and ultimately keep children, young people and their families safe
from abuse and harm.

NHS Fife Clinical Strategy includes a key recommendation specifically recognising the importance
of future health and wellbeing outcomes that can be affected by the relationship between adverse
child hood experiences and future adult health. We understand these effects as being traumatic on
the individual and their ability to engage with health services. Services which understand trauma
can help to respond appropriately when managing care or providing medical interventions, thereby
limiting the additional distress and harm potentially caused to the patients wellbeing. NHS Fife
understands that by providing services which are more trauma informed, we can have more
successful outcomes for the patient and provide care that responds to those individual needs in a
more sensitive way. This is currently evident for those living in Fife who are refugees or asylum
seekers and who have come from backgrounds in which they have been exposed to significant

•     A Fife wide approach to making services more trauma informed will be in place over the next
      four years.

12.     Reducing Stigma of Mental Illness to Eliminate Unlawful Discrimination

NHS Fife will continue to take forward work to address the stigma of mental health but in addition
address inequalities within service provision.

Following the launch of the National Mental Health Strategy for Scotland 2012-2015, NHS Fife and
partners developed the ‘What Matters to you? Mental Health Strategy for Fife’ (2013-2020).

NHS Fife understands that one in four people will experience mental health problems or illness
during their life. This is therefore a priority area and one which features in the Clinical Strategy
recommendation to ‘reconfigure services and resources so that there is equity of access to service
across Fife and all patient groups’.

Access to specialist mental health services must be provided recognising that mental health needs
are evident across all communities including those who are speakers of other languages, those
who speak British Sign Language and those affected by learning difficulties or disabilities.

Inequality exists where they don’t have the same access to those services. NHS Fife will work
within the reconfiguring of the services to ensure that access is available for all and that we identify
additional measures which improve engagement for communities from other cultures or

• NHS Fife will ensure that those facing multiple disadvantage and marginalisation as a result of
    their characteristic, culture, background or community combined with a mental health issue or
    illness will be at the forefront of the redesign of services, thereby reducing inequalities currently
    excluding them from recovery or reconnection.

NHS Fife aims to promote the anti stigma messages by taking forward the following areas of work:
•   Pass the Badge
•   Walk a Mile
•   The Power of OK

13.     Improving Access to Services for People Experiencing Discrimination on
the Grounds of Poverty.

NHS Fife will continue to work towards reducing health inequalities and discrimination experienced
as a result of living in poverty.

The Fairer Fife Commission was set up by Fife Council to provide independent advice and insight
into the priorities for tackling poverty and inequality in Fife. The commission met six times during
2015 and was tasked with proving evidence of poverty and inequality in Fife.

The Commission produced a report called ‘Fairness Matters’ (Fairer Fife Commission, 2015) which
included reported a series of recommendations, including several recommendations on health. The
recommendations have been accepted by the Fife Partnership, which includes NHS Fife as a key
partner, and agreed an action plan (Fairer Fife Commission, 2015).

The Commission recommended that NHS Fife should ‘contribute to a reduction in inequalities over
and above the obvious provision of public health services and integration agenda’ (e.g. as an
employer, a procurer of goods and services and strong community planning partner).

Alongside the work of the Fairer Fife Commission, Fife Health and Wellbeing have launched their
new strategy to reduce Health Inequalities called, the ‘Fairer Health Strategy’ (2016-2020). The

report promotes the use of current evidence as to what works to reduce Health Inequalities and
provides support for people, communities and organisations to change the way they link together,
co creating better health in the process.

NHS Fife understands that discrimination and prejudice of those living in poverty reduces their
ability to improve their health and achieve equity from health services. ‘In men and women
combined, partial life expectancy at 40 years was reduced by more than 2 years because of
low socioeconomic status’ (Stringhini, et al 2017).

NHS Fife working with our Community Planning Partners will support actions taken to mitigate the
results of welfare reform, in order to reduce discrimination.

In practice, we will:
•     Focus efforts which enable staff to recognise the combined negative impact and nature of both
      the characteristic of the individual and situation in generating inequalities and strategies for
      them to adopt to address this.
• We will provide staff training on the impact of poverty
•     We will continue to develop our partnerships across community planning and within the
      ‘locality’ arrangements, providing support for public health initiatives and efforts to improve the
      local infrastructure which is in the spirit of sustaining and optimising health and wellbeing.
•     It is envisaged that many partnerships between services will develop in the ‘community hub’
      setting. These ‘hubs’ will aim to address social disadvantage for the patient (NHS Fife Clinical
      Strategy, 2016-2021).
•     The NHS Fife ‘Carers and Patients Information Point’ will support signposting thereby
      advancing equality of opportunity.

14.     Providing Ethically Sourced Goods and Services.

NHS Fife will ensure that goods and services are purchased from ethical providers, continuing to
build on our original outcome from 2013-2017. This outcome is now embedded as ethical
procurement must be an integral element of the operational partnerships and agreements with
providers. However much further work is required to ensure that all documentation used to
contractually agree procurement arrangements will be included in future locally agreed service
level agreements, requesting a copy of the providers’ equality policy or statement equivalent with
regard to the Equality Act (2010).

NHS Fife will work within given NHS Services Scotland National Procurement Policy.

Working locally and securing contracts which are ethically founded will support Equality and
Human Rights approaches and good practice beyond the NHS activity and ensure that we extend
and demonstrate our commitment. Our intention to commission and procure local services by NHS
Fife also enables us to contribute to addressing inequalities for local population by securing
employment and local economic growth for all.

The 20:20 Framework for Quality, Efficiency and Value calls on health services to refocus “efforts
on the Triple Aim of improving Quality of Care (including safety), Health of the Population and
Value and Financial Stability” 2020 Framework for Quality, Efficiency and Value, Scottish
Government, June 2014. Fairness Matters, The Fairer Fife Commission, November 2015 supports
the need for NHS Fife to further embed its ethical practice to reduce health inequalities at a local
level      by       increasing       local       procurement        from       local       sources.

NHS Fife Equality Outcomes Plan
Providing Patient Centred Care

NHS Fife Clinical Strategy

Prevention and Health Improvement

Models of care will be developed that will better integrate physical and mental health care and to support all
people to become more self resilient and able to cope with exacerbations of ill health in order to live better lives.

Equality Outcome 1

Patients living with a disability are supported to effectively manage their own health.


In 2014, those with a long-term limiting condition have considerably lower levels of good/very good general health than the rest of the
population (27.5% compared with 88.6% in the non-disabled group). (Scottish Census, SSCO Official Statistics report; Scottish Government,

In 2015, the proportion of adults reporting to be in 'very good' or 'good' health declined with age from 88% of those aged 16-24 to 55% of those
aged 75 and over. (Scottish Health Survey; Scottish Government, 2015).


Equality and Human Rights Lead, NHS Fife
Speech and Language Therapy, NHS Fife
Health Promotion Fife, NHs Fife
Mental Health, NHS Fife
Learning Disability Service, NHS Fife

What we aim to             How will we How will we measure                      Partnership           Protected Characteristic      Strategy
     achieve?                 do this?                     progress?
Improve awareness of       Provide              Create a baseline of current    Learning        Disability       Advancing
health literacy and its    accessible           accessible and formatted        Disability      Mental Health    Opportunity
                                                                                                                                     Patient Rights
application in practice    communication        information by category and     services        Learning         Eliminating      (Scotland) Act 2011

for patients living with   training for staff   by health condition.                            Disability       Discrimination
a disability (including                         Assess gaps in current          Mental Health   Age                                  HSCP Approved
                                                                                                                                  Strategic Plan2016-19
physical, mental or                             patient information available   Services
those who are                                   by category and health          Health
                                                                                                                                  HSCP Strategic Plan
speakers of British                             condition.                      Promotion                                             Summary
Sign language).
                           Write an             Continue to have available      Speech and
                           accessible           access to Photosymbols and      Language
                           communication        accessible packages which       Therapy
                           policy and           support the development of

                           produce              easy read versions building     Participation
                           guidance             capacity across the NHS and     and
                           documents for        with partners.                  Engagement
                           staff.               Public and patient              Network
                                                consultation and involvement

                           Provide health       will ensure and assure

                           literacy training    quality.

                           for staff

What we aim to            How will we How will we measure                     Partnership             Protected Characteristic         Strategy
        achieve?             do this?                 progress?
Reduce inequalities in    Improving           Assess current ways in which Care and             Disability            Advancing
health experienced by     awareness and       we identify patients who        Clinical          Mental Health         Opportunity
those living with a       preparation for     require additional support to   Governance        Learning              Eliminating
disability by improving   the needs of        access appointments and         Group             Disability            Discrimination
their experience of       disabled            build new measures such as      (divisions) and   Age
care.                     patients prior to   with e health and patient       Committee         And           those
                          their               records to ensure we are                          affected        by
                          attendance.         fully prepared for the          Patient records   adverse
                                              patient’s needs and                               experiences
                                              concerns.                       E health

                                              Make staff more aware of the
                                                                              Primary Care
                                              additional patient’s needs
                                              and concerns via staff
                                              awareness and training.

                                              Continue to improve
                                              accessibility to services
                                              making them more locally
                                              accessible in the community

What we aim to          How will we How will we measure              Partnership             Protected Characteristic    Strategy
     achieve?             do this?           progress?
Improving               Provide      Conduct an audit of             NHS Fife          Disability       Eliminate
accessibility to        accessible   premises-such as signage        Equality and      Learning         Discrimination
facilities for people   buildings.   and management of facilities    Human Rights      Disability
with a disability.                   for disabled patients.          Strategy Group    Mental Health
                                                                     Facilitates and
                                     Audit the accessibility and
                                     functionality of Loop Systems
                                     Plan and publish the location   and
                                     of Loop Systems and             Engagement
                                     maintenance of these.           Network

                                     Promote Deaf Awareness          Hard of Hearing

                                     week to improve staff           groups

                                     knowledge and public

                                                                     BSL service

                                                                     BSL Users

NHS Fife Clinical Strategy


Access to timely palliative and end of life care in the setting that the patient wishes and that can meet their needs,
regardless of age, diagnosis or location.

Equality Outcome 2

Spiritual needs of patients are met.


Chief Executive Letter (2008) 49 – Spiritual Care” and is further supported by the “Local Delivery Plan for Spiritual Care within NHS Fife”.


Spiritual Care Team, NHS Fife
Patient Relations Team, NHS Fife
Equality and Human Rights Lead, NHS Fife

What we aim          How will we          How will we measure              Partnership          Protected Characteristic       Strategy
to achieve?          do this?             progress?
Increase             Ensure that          Assess baseline of staff         Chaplaincy           Race          Foster Good
provision and        spiritual needs      knowledge.                       Service and          Religion      Relations
                                                                                                                                  Spiritual Care Letter
knowledge of the     are identified.                                       religious / belief   Belief
spiritual needs of                        Provide training and             partners.            Ethnicity     Eliminating
diverse patients.    Produce a            awareness of spiritual needs.                         Disability    Discrimination
                     spiritual guidance                                    NHS Fife Acute
                     document for         Publish the range of spiritual   Operating                          Advancing
                     staff which          care provisions available.       Division.                          equality of
                     considers the                                                                            opportunity
                     interconnection      Produce an easy reference        NHS Fife Equality
                     between religion     guide for staff.                 and Human
                     and or belief and                                     Rights Strategy
                     the other                                             group.

Prevention and Health Improvement

NHS Fife Clinical Strategy

Prevention and Health Improvement

Resources will be prioritised to improve our populations lifelong health and wellbeing including maternal and child
health, where appropriate interventions may be particularly valuable in prevention ill health. This includes early
detection and vaccination initiatives to reduce the burden of preventable disease.

Equality Outcome 3

Health of the Gypsy Traveller Community is improved.


Fife Health Needs Assessment 2013

Gypsies and Travellers suffer from poor health and lower life expectancy, differences in life expectancy of over 10% less than the
general population and that the health of Gypsies and Travellers starts to deteriorate markedly when individuals are over 50. High infant mortality
rates, high maternal mortality rates, low child immunisation levels, mental health issues, substance misuse issues and diabetes are also
highlighted as areas of concern. (Ryder et.al. 2012).

Gypsy/Travellers in Fife experience Health Inequalities on many different levels; uptake of services is often hindered by poor literacy skills, low
expectations and perceptions of prejudice (NHS Fife Gypsy Traveller Needs Assessment, 2013).


NHS Fife Multiagency Gypsy Travellers Steering Group
Scottish Ambulance Service
Fife Council

What we aim       How will we            How will we measure                Partnership            Protected Characteristic            Strategy
 to achieve?         do this?                      progress?
Improve access   Create a                A full evaluation will be         Gypsy Traveller    Race            Foster Good Relations
to services.     participative and       published and learning will       Community          Belief          Advancing                 Gypsy traveller
                                                                                                                                      needs assessment 20
                 engaging health         be used to highlight lifestyles                      Religion        Opportunity
                 program as a test       and cultures to various staff     Queens Nursing     Disability      Eliminating
                 of change.              groups.                           Institute (QNIS)                   Discrimination           QNIS Bid Outline

                 The program will
                 determined by           Assess the level of               Voluntary sector
                 Gypsy Travellers        knowledge of health services      providers                                                   Realistic Medicine
                 residing on one         and action improvements in
                 local authority site.   the range of information          Fife Council
                                         provided in accessible/
                                         appropriate formats which         NHS24
                 Build on the needs      are culturally sensitive.
                 assessment in                                             Scottish
                 2013 by working         Evaluate the effectiveness of     Ambulance
                 with the community      the Gypsy Travellers              Service
                 to explore their        Steering group partnership
                 knowledge of            and activity and conduct an       Fife Centre for
                 health services.        Equality Impact Assessment.       Equalities

                                         Establish a three year action
                                         plan to address inequalities
                                         in health-taken from the

EQIA and QNIS evaluation.

Involve Gypsy Travellers in
the multi agency steering

Collate and Analyse Gypsy
Travellers access to health
via E health systems with a
view to understanding Gypsy
Travellers locally used routes
into health.

Assess current levels of
registration at local General
Practices. Work with
partners to identify Gypsy
Travellers in Fife currently
not living on sites or known
in housing, including those
arriving here from other
European countries.

Increase registration at local
General practice.

What we aim         How will we           How will we measure                Partnership            Protected Characteristic            Strategy
 to achieve?           do this?                   progress?
Improve staff      Plan and promote       Plan and implement the            Gypsy Travellers   Race            Foster           Good
knowledge and      a campaign to          campaign and include              Steering Group     Ethnicity       Relations,                Gypsy traveller
                                                                                                                                       needs assessment 20
cultural           promote Gypsy          gathering of patient and staff                                       Advancing
awareness of       Traveller health to    feedback.                         NHS Health                         Opportunity
Gypsy Travellers   staff and visitors                                       Scotland                           Eliminating
lifestyles and     throughout NHS                                                                              Discrimination
health issues.     Fife.

                   Continue to
                   promote the            Measure uptake of the e-
                   recently devised e     Learning Gypsy Traveller
                   learning module on     module.
                   Gypsy Traveller
                   history and culture.   Promote module via linking it
                                          to additional e learning, staff
                                          induction and other methods
                                          of learning for staff to
                                          increase uptake

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